International working group releases standardised diagnostic criteria for canine cognitive dysfunction syndrome
An international team of canine cognition experts has developed the first standardised guidelines for diagnosing and monitoring canine cognitive dysfunction syndrome (CCDS), commonly known as canine dementia. The guidelines, published in the Journal of the American Veterinary Medical Association, aim to provide veterinarians with practical diagnostic criteria to help senior dogs experiencing cognitive decline.
Led by Dr Natasha Olby, Dr Kady M. Gjessing and Rahna M. Davidson, Distinguished Chair in Gerontology at North Carolina State University, the working group brings together leading experts who have either actively researched CCDS or historically set standards in the field, from those who first defined the condition to those who translated it into clinical practice.
The need for standardisation
Until now, veterinarians have lacked a unified approach to diagnosing CCDS, despite seeing the condition with increasing frequency in ageing dog populations.
“We are seeing CCDS diagnoses with increasing frequency, but there isn’t a standardised method for the diagnosis,” Dr Olby explained. “We wanted to propose that standardised method as a starting point that can be built upon over time.”
The absence of standardised diagnostic criteria has also hindered research into potential treatments. “The good news here is that there is increased interest in finding treatments for CCDS,” Dr Olby added. “But in order to develop those treatments we must first be sure there’s an agreed upon definition of the condition.”
Understanding canine dementia
Similar to Alzheimer’s disease in humans, CCDS is defined as a chronic, progressive, age-associated neurodegenerative syndrome characterised by cognitive and behavioural changes that affect daily life to varying degrees.
The condition manifests through changes in several behavioural domains, collectively remembered by the acronym DISHAA:
- Disorientation: Getting lost in familiar environments, staring at walls or into space
- Social Interaction: Changes in how dogs interact with family members or other pets
- Sleep disruption: Altered sleep-wake cycles, night-time restlessness
- House soiling: Loss of house-training despite no physical medical cause
- Activity changes: Decreased interest in play, walks or activities they previously enjoyed
- Anxiety: Increased anxious behaviours, especially in previously calm dogs
- Learning and memory impairment: Difficulty learning new tasks or forgetting previously learned commands
Three severity stages
The guidelines propose three severity stages to help veterinarians and owners understand the progression of CCDS:
Mild CCDS: Signs are subtle, occurring with low frequency or severity, whilst function remains largely preserved. Dogs may occasionally seem confused or show minor changes in routine behaviours.
Moderate CCDS: Behavioural changes become more apparent and begin to impact daily life, requiring management adjustments. Owners may need to modify routines or provide additional support.
Severe CCDS: Debilitating deficits become overt, significantly impairing basic functions and necessitating comprehensive support. Dogs at this stage may require round-the-clock care.
Diagnostic framework
The working group created a diagnostic flowchart with two levels of certainty:
Level 1 diagnosis requires:
- Consistent history of progressive DISHAA signs
- Physical, orthopaedic and neurological examination to rule out other causes
- Laboratory work to exclude alternate conditions
- Either a normal neurological examination or evidence of symmetrical, diffuse forebrain dysfunction
- Persistence of signs following management of relevant comorbidities
Level 2 diagnosis additionally includes:
- Brain MRI showing cortical atrophy
- Cerebrospinal fluid (CSF) cell counts within normal limits
Definitive post-mortem confirmation relies on histopathological evidence, including cortical atrophy, amyloid deposition, myelin loss, neuroinflammation and amyloid angiopathy.
Screening recommendations
The guidelines recommend a proactive approach to monitoring senior dogs:
From age seven: Veterinarians should begin monitoring dogs for cognitive changes via routine senior dog surveys.
When concerns arise: If behavioural abnormalities are reported, follow-up with a more detailed CCDS scale questionnaire is recommended, with ongoing monitoring every six months.
From age ten: Use of a CCDS scale every six months is recommended for all dogs, regardless of whether owners have reported concerns.
Following positive screening results, veterinarians should conduct thorough physical and neurological examinations, including brain imaging where possible, to rule out other conditions that might cause similar symptoms.
Why this matters for dog owners
For dog owners, these guidelines represent an important step forward in recognising and addressing cognitive decline in ageing pets. Many behavioural changes associated with CCDS are often dismissed as ‘just getting old,’ but the condition is a genuine medical syndrome that deserves attention and management.
The standardised approach means veterinarians across different practices will now use the same criteria to assess cognitive function, leading to more consistent diagnoses and better opportunities to track the condition’s progression.
Importantly, the guidelines emphasise ruling out other medical conditions that can mimic CCDS symptoms. Conditions such as arthritis pain, urinary tract infections, thyroid problems or other age-related illnesses can cause behavioural changes that might be mistaken for dementia. A proper diagnostic workup ensures dogs receive appropriate treatment for their actual condition.
Looking to the future
The working group designed the guidelines as a “working live document” that can evolve as understanding of CCDS improves.
“We recognise that this document is just the start of the process, but it was developed as a working live document that can be added to over time as our understanding improves,” Dr Olby said.
Future priorities identified by the group include developing blood biomarkers and cognitive testing batteries suitable for routine clinical settings. These tools would refine diagnostic accuracy and enable better monitoring of therapeutic interventions.
The research team hopes that establishing a workable definition of CCDS and practical diagnostic criteria will pave the way towards improved diagnostics and therapeutics for affected dogs.
The international working group
The CCDS Working Group includes experts from institutions across the globe:
- Natasha Olby and Margaret Gruen: North Carolina State University, USA
- Joseph A. Araujo: Transpharmation Canada, LTD
- Phillipa Johnson: Cornell University, USA
- Eniko Kubinyi: ELTE Eötvös Loránd University, Budapest, Hungary
- Gary Landsberg: Veterinary Behaviour Consultant, Richmond Hill, Ontario, Canada
- Caitlin S. Latimer: University of Washington, Seattle, USA
- Stephanie McGrath and Julie A. Moreno: Colorado State University, USA
- Brennen McKenzie: Loyal Animal Health, Inc., USA
- Monica Tarantino: Senior Dog Veterinary Society, Alexandria, Virginia, USA
- Holger Volk: University of Veterinary Medicine, Hannover, Germany
Practical steps for dog owners
If you have a senior dog, consider these steps based on the new guidelines:
1. Schedule regular senior check-ups: From age seven, ensure your dog has regular veterinary check-ups that include discussion of any behavioural changes.
2. Monitor behaviour: Keep notes on any changes you observe in your dog’s behaviour, sleep patterns, house-training, social interactions or activity levels.
3. Don’t dismiss changes as ‘Just Ageing’: Whilst some slowing down is normal with age, significant behavioural changes warrant veterinary attention.
4. Be proactive from age ten: Request CCDS screening as part of your dog’s routine examinations from age ten, even if you haven’t noticed obvious problems.
5. Work with your vet: If CCDS is suspected or diagnosed, work closely with your veterinary team to rule out other conditions and develop an appropriate management plan.
Support and resources
The work was published on 24 December 2025 in the Journal of the American Veterinary Medical Association and was supported in part by the American Kennel Club’s Canine Health Foundation (grant #03440).
Dog owners seeking additional information about canine cognitive dysfunction should consult their vet.
The development of these guidelines represents a significant milestone in veterinary medicine’s understanding of canine dementia and offers hope for improved quality of life for senior dogs experiencing cognitive decline.
For more information about the CCDS Working Group Guidelines, veterinarians can access the full publication in the Journal of the American Veterinary Medical Association (DOI: 10.2460/javma.25.10.0668).
